2024 National Provider Enrollment Forum

September 16–18, 2024 | Charlotte, NC

The 2024 National Provider Enrollment Forum delivers engaging education and training to provider enrollment professionals, enrollment managers, and credentialing specialists. Experienced veterans and top industry experts offer best practices and tips for developing and sustaining successful enrollment processes. Whether you’re a newly minted professional or an experienced enrollment specialist, you won’t want to miss this opportunity to get step-by-step training and answers to your most pressing questions!

The 2024 National Provider Enrollment Forum is bursting with innovative speakers, fresh insights, and brand-new sessions!

As always, the National Provider Enrollment Forum provides breakfast, lunch, and snacks and beverages during networking breaks, and a networking reception, all included with registration. Attendees will also have access to an event app that includes all session materials, a session planner, and unparalleled networking with peers.

We hope to see you in Charlotte!

What’s new for 2024?

Hot topics for 2024 include:

  • ERISA regulations
  • The CMS-855A form
  • The CMS-855B form
  • The CMS-855O form
  • The CMS-855I and 855R forms
  • The CMS-855S application

Other features:

  • Speaker lineup with both new names and familiar faces
  • Dedicated Q&A opportunity at the end of every session

2023 National Provider Enrollment Forum

Who Should Attend?

Perfect for professionals in various healthcare settings, The 2024 National Provider Enrollment Forum is the ultimate training event for mastering the enrollment process and ensuring swift reimbursement. Whether you're from a physician's office, home health agency, hospital, rural health clinic, or elsewhere, join us to enhance your skills, stay updated on industry best practices, and network with peers—all geared towards maximizing revenue potential for your organization.

Who Should Attend?

  • Provider enrollment leads professionals
  • Credentialing specialists
  • Enrollment specialists
  • Payer credentialing manager
  • Provider enrollment managers and supervisors
  • Practice administrators
  • Practice enrollment managers
  • Medical staff coordinators and professionals
  • Medical staff services directors and managers
  • Credentialing professionals
  • Medical staff leaders
  • Medical staff committee members
  • Quality directors and managers
  • Chief medical officers
  • Vice presidents of medical affairs

2023 National Provider Enrollment Forum

Agenda

Monday, September 16, 2024

5:00 p.m. – 6:00 p.m.
Welcome Networking Reception (Exhibit Hall)

Tuesday, September 17, 2024

7:00 a.m. – 8:00 a.m.
REGISTRATION & BREAKFAST

8:00 a.m. – 9:15 a.m.
I&A, PECOS, and NPPES: Setting Up Providers and Suppliers
David J. Zetter, PHR, SHRM-CP, CHCC, CPCO, CPC, COC, PCS, FCS, CHBC, CMUP, PESC, CMAP, CMAPA, CMMP, CMHP
Learn how the Identity & Access management System (I&A) works in tandem with the Provider Enrollment, Chain, and Ownership System (PECOS); and the National Plan and Provider Enumeration System (NPPES) during the provider enrollment process for providers and suppliers.

  • Know how to register providers in NPPES
  • Know how to register providers and users in I&A
  • Understand the importance of multifactor authentication for I&A
  • Know how to become a registered surrogate on behalf of your organization as an Authorized Official (AO)/Delegated Official (DO)
  • Know and list the responsibilities of an AO/DO and explain how to add staff end users
  • Know how to make connections to act on behalf of providers/suppliers

9:15 a.m. – 9:45 a.m.
NETWORKING & REFRESHMENT BREAK (Exhibit Hall)

9:45 a.m. – 10:45 a.m.
Navigating CMS-855A: Mastery for Institutional Providers
Larry DeHoyos, CPCS
Heather Blair
Join us for an in-depth exploration of the CMS-855A form, a critical document for institutional providers enrolling in Medicare. Gain advanced knowledge about specific requirements and documentation needed for hospitals, skilled nursing facilities, and other institutions. Review detailed case studies and receive expert tips on navigating complex scenarios encountered in institutional provider enrollment.

  • Explain the specific requirements for institutional providers on the CMS-855A
  • Describe how to accurately complete and submit the form
  • Identify common pitfalls and how to avoid them

11:00 a.m. – 12:00 p.m.
Expertise in CMS-855B: Clinics and Group Practices Enrollment
Larry DeHoyos, CPCS
Heather Blair
Join us in taking a deep dive into the CMS-855B form, which is essential for clinics, group practices, and certain other suppliers. Delve into the intricacies of the form, such as organizational structure documentation, service-specific requirements, and compliance with Medicare standards. Participate in practical exercises to solidify understanding and improve accuracy in form completion and submission.

  • Explain the requirements for clinics and group practices in the CMS-855B form
  • Describe the process of filling out and submitting the form
  • Identify common errors and provide strategies to ensure accuracy

12:00 p.m. – 1:00 p.m.
NETWORKING LUNCH—Provided (Exhibit Hall)

1:15 p.m. – 2:15 p.m.
ERISA: The Law That Places the Power Over Payers in Your Hands, Part 1
David J. Zetter, PHR, SHRM-CP, CHCC, CPCO, CPC, COC, PCS, FCS, CHBC, CMUP, PESC, CMAP, CMAPA, CMMP, CMHP
Payers don’t want you to know how much control you really have regarding your claims’ reimbursement. They don’t want you to know that by applying ERISA regulations, you can force your payers to pay your claims more quickly, stop downcoding your office visits, overturn claims that were previously denied, expand inadequate appeal deadlines, and return recouped funds previously taken from your practice. Come learn how to utilize the applicable portions of ERISA regulations to have more control of your payer requirements and reimbursements.

  • Understand how to utilize ERISA regulations to your advantage
  • Explain what an advanced benefit determination is and how it can help you
  • Recognize the importance of a summary plan description
  • Identify what ERISA protections are available to your practice

2:15 p.m. – 2:35 p.m.
NETWORKING & REFRESHMENT BREAK (Exhibit Hall)

2:35 p.m. – 3:35 p.m.
ERISA: The Law That Places the Power Over Payers in Your Hands, Part 2
David J. Zetter, PHR, SHRM-CP, CHCC, CPCO, CPC, COC, PCS, FCS, CHBC, CMUP, PESC, CMAP, CMAPA, CMMP, CMHP
We continue our deep dive into ERISA, the law that governs the majority of your non-Medicare/Medicaid claims. The complexities of ERISA regulations will be broken down into plain English, leaving attendees with actionable advice on how to use it to gain more control of your payer requirements and reimbursements. By mastering the complexities of ERISA, you can significantly increase your reimbursement and reduce the number of hoops that payers require you to jump through to get paid.

  • Understand how to utilize ERISA regulations to your advantage
  • Explain what an advanced benefit determination is and how it can help you
  • Recognize the importance of a summary plan description
  • Identify what ERISA protections are available to your practice

3:45 p.m. – 4:45 p.m.
Provider Enrollment Collaborative Solution Finding Session
Jenny Jackson, EdD, MBA, CPMSM, CPCS, FMSP
Brianna Foulkrod, CPMSM, CPCS
Mathieu Gaulin, CPMSM, CPCS

This fully collaborative and interactive session breaks the audience down into small groups in order to explore real-world common challenges in provider enrollment. The goal here is to network with other MSPs, share crazy stories that we have encountered in the field, and to have a little fun.

  • Analyze common challenges in provider enrollment
  • Evaluate best practices to tackle provider enrollment issues
  • Formulate ways to be more proactive in the future

Wednesday, September 18, 2024

7:00 a.m. – 8:00 a.m.
BREAKFAST (Exhibit Hall)

8:00 a.m. – 9:00 a.m.
Tomorrow's Leader Today
Jenny Jackson, EdD, MBA, CPMSM, CPCS, FMSP
Brianna Foulkrod, CPMSM, CPCS
Mathieu Gaulin, CPMSM, CPCS

Learn tips from MSPs in the trenches on how to use professional presence, adaptability/rebounding and vulnerability to become tomorrow's leader today. This session will mix in personal leadership stories, moments of vulnerability as well as practical tips for those in the room to consider as they think through their leadership struggles.

  • Learn tips for rebounding from professional setbacks 
  • Employ a professional presence to help you internally and externally 
  • Demonstrate vulnerability to open the door to tomorrow’s leadership traits 

9:00 a.m. – 9:30 a.m.
NETWORKING & REFRESHMENT BREAK (Exhibit Hall)

9:30 a.m. – 10:30 a.m.
Credentialing and Provider Enrollment: Two Sides to the Same Coin
Mathieu Gaulin, CPMSM, CPCS
Christina Giles, MS

Are you hearing the word credentialing being used differently by people these days? There are many functions coming under the umbrella of credentialing but maybe we need to look at the similarities and differences of the functions. This session will review the functions of traditional credentialing and provider enrollment, compare and contrast the tasks, and suggest ways that working together may not only enhance the two processes, but could offer some new job opportunities.

  • Distinguish the similarities and differences between credentialing specialists and provider enrollment specialists
  • Analyze the basics of each profession to better understand areas of collaboration and opportunity
  • Theorize why both heads and tails makes for an optimal career development pathway

10:40 a.m. – 11:40 a.m.
Comprehensive Guide to CMS-855O: For Ordering and Certifying Practitioners
Heather Blair
Larry DeHoyos, CPCS
Join us in delving into the CMS-855O form, which is crucial for practitioners who order or certify Medicare services but do not directly bill. Gain insights into the intricacies of non-billing practitioner enrollment and compliance with Medicare’s ordering and certifying regulations. Discover strategic approaches to handle common challenges and streamline the enrollment process for these practitioners.

  • Describe the purpose and use of the CMS-855O for specific practitioners
  • Explain a step-by-step process for filling out and submitting the form
  • Identify key areas of focus and common oversights to avoid

11:40 a.m. – 12:40 p.m.
NETWORKING LUNCH — Provided (Exhibit Hall)

12:40 p.m. – 1:40 p.m.
Mastering CMS-855I & 855R: A Guide for Individual Practitioners
Larry DeHoyos, CPCS
Donna Goestenkors, CPMSM, EMSP

Join us for a comprehensive understanding of the CMS-855I & 855R forms, which are used by individual physicians and non-physician practitioners and when reassignment is needed to bill through a group. Dissect each section of these forms, learning about credential verification, licensure requirements, and the nuances of different practitioner types. Enhance your skills in facilitating efficient and error-free enrollment processes for individual practitioners.

  • Describe the CMS-855I form's role for individual practitioners
  • Identify the steps involved in accurately completing the form
  • Explain tips for efficient processing and common mistakes to avoid

1:50 p.m. – 2:50 p.m.
Demystifying CMS-855S: DMEPOS Supplier Enrollment
Heather Blair
Larry DeHoyos, CPCS

Join us in exploring the CMS-855S form for DMEPOS suppliers. Discover the specificities of DMEPOS supplier enrollment, including documentation requirements, adherence to Medicare quality standards, and the nuances of billing for equipment and supplies. Understand the complexities of DMEPOS enrollment and develop strategies for efficient processing and compliance.

  • Explain the specific requirements of the CMS-855S for DMEPOS suppliers
  • Describe the detailed process of accurately completing and submitting the form
  • Identify common challenges and best practices for successful enrollment

2:50 p.m. – 3:05 p.m.
NETWORKING & REFRESHMENT BREAK (Exhibit Hall)

3:05 p.m. – 4:05 p.m.
Navigating the Maze of Medical Enrollment With Insurance Companies
Emily Walker, CPC
Are credentialing denials causing delays in getting paid and frustrating you? Feeling lost in the ever-changing maze of payer requirements? Attend this essential session and empower yourself to navigate the credentialing process with confidence and clarity. This session equips you with the knowledge and tools to conquer credentialing challenges, minimize denials, and maximize your income.

  • Explain basic credentialing terms and what they mean
  • Differentiate between different types of insurance plans.
  • Apply processes to streamline filling out credentialing applications

4:05 p.m.
Conference concludes


— Agenda subject to change —

2023 National Provider Enrollment Forum

Speakers

Heather Blair

Heather Blair 
Credentialing and Licensing Manager, Saisystems Health

Heather Blair is an accomplished healthcare operations professional with 24 years of diverse experience spanning provider enrollment, credentialing, coding, nursing, licensing, and contracting. From clinics and hospitals to skilled nursing facilities, ambulances, pharmacies, surgery centers, and independent diagnostic testing facilities, she has worked with a wide array of provider specialty types and entities. She holds a Master's in Healthcare Administration and a Bachelor's of Science in Nursing, and certifications as a Certified Professional Medical Auditor and Certified Evaluation and Management Coder. As a dynamic speaker for Team Med Global, Blair brings her passion for healthcare and expertise in credentialing and licensing to the forefront, captivating national audiences with her insights, practical advice, and engaging presentation style.

Larry DeHoyos

Larry DeHoyos, CPCS
Team Member, Team Med Global Healthcare Consulting

Larry DeHoyos has been involved in the medical staff services, quality management, credentialing, provider enrollment, and revenue cycle industries for over 22 years. His experience extends through medical groups, hospital systems, managed care plans, and CVO environments. He is currently based in the Boston area where he is the director of credentialing for a nurse staffing platform for post-acute care facilities. DeHoyos is a subject matter expert in provider enrollment, practice management, and acquisitions and integrations. He also serves as associate faculty and as a member of the speaker team with Team Med Global, where he has developed and facilitated several webinars and educational workshops on Lean workplace efficiencies, provider enrollment, provider credentialing, CVOs, accreditation preparedness, and practice management.

Brianna Foulkrod

Brianna Foulkrod, CPCS, CPMSM
Director, Credentialing, Texas Health

Brianna Foulkrod brings over 17 years’ experience in the healthcare industry. She is currently the director of credentialing for Texas Health Physicians Group, based in Dallas, Texas. Her experience includes many aspects of credentialing including privileging, medical licensing, delegated credentialing, provider enrollment, CVO operations, and leadership. She serves and volunteers for both national and state associations. She is a Certified Professional in Medical Services Management and a Certified Provider Credentialing Specialist and speaks nationally on many industry related topics.

Mathieu Gaulin

Mathieu Gaulin, CPMSM, CPCS
Senior Director, Professional Medical Staff Services, Boston Children’s Hospital

Mathieu Gaulin has been at Boston Children’s Hospital since 2006, starting as an agency temporary employee. He worked in provider enrollment for 10 years, during which time he created and managed the centralized provider enrollment team. Currently, he is the senior director of professional medical staff services; in this role, he oversees medical staff services and provider enrollment while working with the medical staff and its leaders on their self-governance and oversight of patient safety and quality obligations. Gaulin is currently a member of the Board of Advisors of Medallion, Inc. and the Institute of Contemporary Art/Boston. He previously served on the National Association Medical Staff Services Membership Committee and as the secretary of the Massachusetts Association of Medical Staff Services. He is also a national speaker and thought leader in multiple medical staff domains.

Donna Goestenkors

Donna Goestenkors, CPMSM, EMSP
President, Team Med Global Healthcare Consulting

Donna Goestenkors is a consultant, speaker, author, educator, and mentor with more than 48 years of knowledge and experience that she is privileged to share with colleagues, healthcare administrators, and medical staff leaders on issues pertinent to the medical staff services industry. Her expertise penetrates all healthcare locations and environments, including health systems; academic, community, and critical access hospitals; credentials verification organizations; payer enrollment; managed care organizations; and group and solo practice settings. Her talent in leading medical staff services professionals to their highest competence garners Goestenkors great respect among her industry colleagues.

Christina W. Giles

Christina W. Giles, MS
President, C. Giles & Associates

Christina W. Giles has been a consultant and speaker for over 40 years. She specializes in educating, training, and orienting credentialing and medical staff services personnel, medical staff leaders, and MSPs, as well as in administrative functions such as accreditation survey preparation, credentialing, privileging, and peer review; assessment and development of medical staff governance documents; and policies and procedures. She presents nationally on many topics, including accreditation preparation, credentialing, privileging, and medical services management, efficiency, and effectiveness of processes. She is also co-founder of Edge-U-Cate and faculty for Edge-U-Cate’s Credentialing Schools, administrative manager for the Certification Focused Study Programs, and part of Edge-U-Cate’s Speakers’ Bureau. She was inducted into the NAMSS Hall of Fame in 2017.

Jenny Jackson

Jenny Jackson, EdD, MBA, CPMSM, CPCS, FMSP
Senior Director, Provider Enrollment & Onboarding, Community Health Systems, Inc.

Jenny Jackson is a medical service professional with 22 years of experience in managed care and provider enrollment. She is the senior director of provider enrollment and credentialing verification services for Community Health Systems in Nashville, Tennessee. Jackson is passionate about developing other leaders and specializes in building strong teams through communication, empathy, and trust. She believes that practicing servant leadership and putting people first is fundamental to the success of every organization. Jackson is a past president of the Kentucky Association of Medical Staff Services, a Certified Professional in Medical Services Management, a Certified Provider Credentialing Specialist, and a Fellow of the National Association Medical Staff Services. She holds an MBA and an educational doctorate in organizational leadership from Western Kentucky University.

David J. Zetter

David J. Zetter, PHR, SHRM-CP, CHCC, CPCO, CPC, COC, PCS, FCS, CHBC, CMUP, PESC, CMAP, CMAPA, CMMP, CMHP
Founder & President, Zetter Healthcare Management Consultants

David J. Zetter is founder and president of Zetter HealthCare LLC. He and his firm have provided practice management consulting services to medical and dental practices, facilities, and organizations for more than 25 years. Zetter is a nationally recognized enrollment expert and speaker, and CMS regularly solicits his feedback in their PECOS and compliance user focus groups. He is the current president of the National Society of Certified Healthcare Business Consultants and a Certified Professional Coder (CPC) for physician practices, hospitals, and facilities. Zetter is a member of the American Health Lawyers Association, the Medical Group Management Association, and the Healthcare Financial Management Association. His firm supports client practices and facilities in all 50 states.

Emily Walker

Emily Walker, CPC
Founder and CEO, Integrity Medical Credentialing

Emily Walker is a seasoned navigator in the intricate world of medical credentialing and consulting. She has helped countless providers across various specialties secure their credentials and confidently embark on their professional journeys. Her dedication lies in empowering individuals with the knowledge and tools necessary to streamline the credentialing process, minimize frustrations, and maximize efficiency. More than just a consultant, she is a trusted advisor. She takes the time to understand specific needs and goals, providing personalized, transparent, and supportive service throughout the entire credentialing journey.

2023 National Provider Enrollment Forum

Location

Sheraton Charlotte Hotel
555 South McDowell Street, South Tower
Charlotte, NC 28204

HCPro LLC/DecisionHealth has no affiliation with any third-party companies or travel assistance providers. Rooms should be booked directly with the event hotel using the official information provided on the website and in the brochure.

2023 National Provider Enrollment Forum

Learning Outcomes

After attending this conference, learners will be able to:  

  • Describe the process of filling out and submitting the CMS-855A, CMS-855B, CMS-855O, CMS-855I, CMS-855R, and CMS-855S forms 
  • Analyze the basics of provider enrollment and credentialing to better understand areas of collaboration and opportunity 
  • Navigate the medical enrollment process with insurance companies  

Continuing Education

AAPC
This program has the prior approval of AAPC for 12 continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor.

2024 National Provider Enrollment Forum

Product Code: NPE091624--

Quick Overview

DecisionHealth is happy to announce our 2024 National Provider Enrollment Forum will be held September 16-18, in Charlotte, North Carolina!

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2024 National Provider Enrollment Forum